Books to Improve Mental Health

By: Dr. Citlaly Gonzalez, Clinical Psychologist

Winter weather and a week off of school, what better time to cozy up with a nice pile of books? There is something magical about the world that is waiting inside a book and the places and times you can travel to, the feelings they evoke, and the things we can learn.  

As a psychologist, the opportunity to blend my appreciation for each person’s story and my love of reading has been an incredible thing.  In my work in our Autism Diagnostic Clinic, my job is to include a recommendation to support each child’s development. I find that including a list of book recommendations with each report has been a fun way for parents to support their child’s needs.  

When presented with the opportunity to write a blog about books I would recommend from a mental health lens, I jumped at the chance, but where to start? Books about feelings? Books on tough topics? My favorite children’s books? One blog post can’t cover them all (but maybe a part II or part III can try), so we’ll focus on the magic of reading with your child and what it can do to support connection, increase understanding of feelings and tough situations, and support the child’s sense of self.  

Books on Feelings 

There are so many books about feelings out there! It’s a beautiful thing. It’s best to start with feelings books at your child’s level. This could include introducing basic feelings concepts or stories with more complex social situations. Here are some of my go-to books!  

• For the youngest readers and those whose attention is best supported by simple books try the Feelings Book and Glad Monster, Sad Monster, both of which introduce feelings paired with bright illustrations. Lots of Feelings on the other hand uses photographs for children who might benefit from more realistic representations.  
• In the Boy with Big, Big Feelings, a little boy wonders why he has a “big, giant heart in a world that’s so heavy and kind, where all of the feelings under the sun feel as if they were made to be mine.” He learns that it’s okay to have big feelings and that it can even help us understand and connect with others!   
• A Whole Bunch of Feelings has been a favorite in our house. Each page has a brief introduction to a different feeling paired with an activity or question for discussion. We read a page at breakfast and made it part of our normal routine showing that any time is a good time to talk about our feelings.
• We usually followed up with one page from Breathe like a Bear for a quiet moment of meditation before we get our day started. See the theme, little moments, scheduled regularly, make for some big impact!  
• Think of who and what your child responds to, like their favorite characters. If you have a dinosaur lover, the “How do Dinosaurs” series might be a great place to start. Superhero lovers might be most interested in a book with their favorite characters, Super Heroes Have Feelings Too (DC Super Heroes).

Books on Tough Topics 

Our therapy team is often asked for book recommendations to talk about tough topics. We welcome opportunities to connect families with books that can help them navigate hard discussions. If you are going through a challenging moment, feel free to reach out to your therapist or our mental health team for book recommendations. Your local library may also provide a wealth of resources!  

Photo: Topics to Talk About display at the Berwyn Public Library 

• Books on Making mistakes: For the kids who can’t stand to make a mistake try The Girl Who Never Made Mistakes. Pair it with a conversation about the times you’ve made a mistake and how you recovered. Social-emotional learning happens when children are provided opportunities and models. 
• A Garbage Can Day–  talks about the feelings and choices that come with a rough day. Written by a local therapist and a teacher, this book is paired with a board game for reading and play.  
• When Sadness is at your Door personifies the feeling of sadness, making it easier for younger children to talk about what it feels like for them. It doesn’t look to resolve the problem or make the feeling go away, but to provide language to discuss it, ideas to cope, and reassurance that it is okay to feel deeply.  

• We are often asked for books on grief, change, and loss:  A Memory Box looks at grief from a child’s perspective and suggests an activity to do to keep the person present. The Invisible String uses a more subtle approach and looks at separation, both temporary and permanent, providing language to use when children really miss someone and wished they could be closer. The Fall of Freddie the Leaf is a more abstract book that discusses change through the framework of fear moving toward acceptance. It’s a classic book and good for all ages.  
• It’s not just “therapy books” that can be useful! Sometimes just regular books can open the door to conversation. Alexander and the Terrible, Horrible, No Good, Very Bad Day was a favorite in my home growing up. When one of us was having a bad day, my mom would ask if we were feeling a bit like Alexander. It allowed us to externalize the feeling and provided a touch of humor.   

Books to celebrate your child  

There are tough moments and there are beautiful moments and all of them deserve space and attention. At Easterseals we are dedicated to celebrating each child and their many skills, talents, and unique way of being. The following are some of my favorite books to celebrate children from a strengths-based frame.  (Bonus: These are some of my favorite gifts for my children’s classrooms as a gentle reminder that there are so many ways kids share their gifts!) 

• All the Ways to Be Smart: this beautiful book celebrates the many ways children share their gifts. It’s an important reminder that every child has strengths, and it is our job and joy to find and honor them.  
• All Kids are Good Kids: this simple board book was inspired by a child I saw in our clinic. Her frequent and unexpected behavior led to her belief that she was “bad.” Children (and adults!) don’t always make the best choice, but no child is ever bad, this book reminds us that all kids are good kids. Try these books from the same series too: All Kinds of Kindness, Love Makes a Family 
• I Know a Lot: Another great book to remind kids (and the grown-ups around them) that there are so many important things our kids know, things that matter, things they learn by playing and exploring the world around them. (These books are from the same series too: I am So Brave).  

Books to Support Connection 

• The Rabbit Listened: This is one of my very favorite books for parents to read to their children. Read more about why in this powerful blog written by Natalie Donald, an Easterseals social worker. At its core, the Rabbit Listened gently reminds us that in order to help, we need to first listen. I like to invite parents to identify which animal they think they’re being (Unsurprisingly, I am a chicken. I want to talk talk talk about it all).  Read it with your child and try to see which one you are, and lean in to listen to which one your child best responds to, knowing it can change across situations, moods, and needs.  
• Mama do you love me: This simple board book tells the story of a little girl with a big imagination who wonders what would happen if she did all the things she knew she wasn’t supposed to do. Each time, her mama assures her that some things might make her angry, surprised, or scared, but that no matter what she would still love her, because of who she is.  

The Book You Write Together 

The most important book you read might be the one you write together. How you write it, is up to you and your child.  

• Not all of us can keep up with baby books but we can all keep up with a quick note. I’d like to introduce you to the “My Child Can” journal. Whether it’s in a beautiful notebook, the margins of your planner, or the not-quite-a-book notes app on your phone, the “My Child Can” is a running list of all the milestones and little moments that make you smile. It might be “my child told me they have a best friend” or “My child learned to spell his name.” In this work, we spend a lot of time asking about the things children can’t do (yet), but this journal can be an important reminder of all the things your child can do. You may also choose to work with your child to teach them to do the same and focus on all the beautiful things they can do using an affirmation book. 
• Shared art journal (Draw with Mom): For kids who have started writing and drawing, I love a shared art journal (Draw with Dad). Keep the pressure low and the journal accessible and watch the communication blossom. Some days may be just a scribble or a funny picture while other days might include a more meaningful note, all of it helps support an open line of communication  

Reading is Wellness

Simply reading with your child is the best, no matter what book your reading, the connection between parent/guardian and child, language exposure, and of course the introduction to new themes all have the potential for so many benefits for wellness.

Our Mental Health team often receives requests for books on various themes which we happily oblige. We have recommendations for books on learning about feelings, grief, potty training, divorce, sharing a diagnosis, and more. We have another blog post with recommendations on best children books on disability. We have those recommendations and lots more! But here is my biggest tip, read these books before you think you need them. Have them accessible. Read about all abilities, cultures, and a wide range of challenges and situations. Normalize talking to your child about life challenges, feelings, and tough topics. This way, when a situation of their own comes up, they know it’s okay to talk about it. They will be less resistant to reading about it. They will be more prepared to handle it.  

An added reminder for the parents of children who haven’t yet discovered the magic of books –kids don’t always start out loving books. There was a long stretch of time with my own children when it looked like I was reading to myself or the dog, but I knew that even while running around the room, they were listening. Hearing the stories, exposing them to language, and even the rhythmic reading of toddler books are way to support both connection and reading.

As a bonus recommendation for the kids who are still learning to appreciate books, I love to recommend the Indestructible series and any book with interactive components or buttons. Kids are always taking in pieces from the world around them, whether it’s the words you are reading or the fact that you are sitting, present with them.  

So, if you are looking for a final gift to complete “the something you want, something you need, something you wear and something you read” I hope this list helps you find a new book to add under the tree, a book to quietly add to your library for “just in case” or even a simple surprise for an any day moment to have with your child. 

About Easterseals DuPage & Fox Valley

For additional information on services for children with disabilities, visit: https://www.easterseals.com/dfv/programs-and-services/. The Easterseals’ Mental Health & Family Support team strives to provide children and families with the mental health support they need to help thrive and empower one another. Our work helps caregivers and children experience more joyful interactions through attunement and connection. For more information on our services, contact us at socialservices@eastersealsdfvr.org.

It’s Summer! Let’s Go Ride A Bike!

By: Josephine Hipolito, Physical Therapist

Summertime is approaching, and around this time, caregivers often ask me to work on bike riding with their kids as one of their goals. As an avid cyclist, it’s one of my favorite things to teach because of the joy and freedom children feel when they learn to ride. Let’s start with a few tips on teaching children bike riding.

Things to Consider When Starting

1. Determine whether the child knows how to pedal.  If they do, skip the next section and go to the balance section to work on the balance aspect of bike riding .
2.  Remember you don’t have to follow this step by step. It’s more of a guide to see where your child is in the bike riding process and then proceed.

 Teaching Children Pedaling:  

1. Start with teaching “Air Cycling.” Most kids don’t understand the concept of extending one leg while the opposite leg is relaxed if they have never pedaled before. Their usual instinct if you tell them to push with their legs is to have both legs push simultaneously, so they usually get stuck when on a tricycle.
   
2. To practice the motion of pedaling, place your hands at the bottom of their feet and tell them to push against it on their bent leg. Use a little resistance when you do this. On a tricycle, kids often stop pedaling and move backward when they encounter resistance, so you want them to get used to resistance.

3. Once they master air cycling, start them on a tricycle with a pedal block (a device that holds their feet on the pedals) or strap their feet on the pedals using an ace wrap or velcro straps. Children usually tend to over-push with their feet at first, so their feet slip off the pedals. Wrapping their feet will keep them on the pedals. You can also get commercially available pedal straps like this one.

4. Once they master the pedal block, take off the straps so they can learn to control their leg movement and keep their feet on the pedals.

5. Make sure they master pedaling with a tricycle so that it becomes second nature to them when they graduate to a bicycle.

Balance Bike Versus a Bike with Training Wheels 

I often tell families ready to progress their children from a tricycle to a bike, to start with a balance bike. A balance bike is simply a bike without pedals where children use their legs instead of pedals to move.

Skip the step of learning with training wheels because children can get dependent on leaning on them for balance. The Balance Bike enables the child to learn to find their center of balance on their own  

NOTE: Not everyone will be able to get a balance bike and a bike with training wheels, so I recommend taking the training wheels AND the pedals off of a bike to convert it to a balance bike. 

 Biking with Training Wheels

The problem with a bike with training wheels is the braking system.  They use coaster brakes which means pedaling backward to activate the brakes. 

Kids tend to start pedaling backward when they encounter resistance which activates the brakes. It’s always difficult for kids with motor planning issues to figure this out. That’s why you ensure they master the pedaling part of bike riding before moving on.

Keep an eye out for the following:  

1. Some kids tend to push with their legs while pulling on the handlebars, which causes the bikes to turn – as a PT, this signals to me that they need core strengthening 
2. Some kids will over push with their legs causing them to slip backward on the bike seat – I put a dycem (non-slip pad) or tie a theraband on the seat to prevent this .

 Tips to Use a Balance Bike 

1. Start with having the child walk with their legs while sitting on the saddle. See if they have the control to keep the bike from tipping or even recognize that the bike is tipped while they are riding it. They need to integrate this part. Children with body awareness issues will not even recognize that they are tilted when propelling a balance bike.
2. Watch out for kids who walk the bikes, but they are standing and not sitting on the seat. I sometimes use an ace wrap to secure their pelvis on the seat to prevent this 
3. Once they master keeping the bike upright, work on gliding .
4. Gliding – have them take three steps: 1, 2, 3, then bring their feet up to glide. Challenge them and ask them to see how far they can glide before they put their feet down.
5. I sometimes use floor markings like chalk on the surface to mark a certain point. Children can work on balancing better if they have a visual cue on how far to glide.
6. Once a child can glide for 10-20 feet consistently, I move them to a bike with two wheels (or put the pedals back on the bike).

Steps to Help Children Ride a Standard Bike 

1. Work in a parking lot of a school or a park early in the morning so that it will be empty and there are no distractions – avoid the sidewalks or hallways because the child needs to worry about staying within the confines of the space (it can become too stressful for them).
2. Try to find a parking lot with a little downward incline to help them get a little momentum to balance.
3. Let your child walk the bike out to the parking lot while holding the handlebar. This way, they learn to handle the bike and how to motor plan to keep it balanced.
4. Work on pedaling forward first.  Worry about turns later.
5. Have a gait belt (or Dad’s belt) around their trunk, so you have something to grab onto when they are riding (if they are not using a bike with a parent’s handle).
6. Give them a little push to start them up – they will usually start slow because they are apprehensive but what children don’t realize yet is they need momentum to be able to balance.  
7. Give them frequent breaks, and maybe bring a snack, as bike riding can be stressful while learning. Let them know that they have to do 2-3 laps then they can take a break. Break for 1-2 mins, get a drink or snacks, then return to bike riding. Use a timer so they know break time is over when it rings. This way, they may be more cooperative when they know they have a break.
8. Once they master going straight, you can work on turning – put cones on each end of the parking lot and ask them to turn around the cones. This way, they can practice tight turns.
9. Once they master turning,  work on tighter areas (e.g. a hallway, sidewalk) to narrow their space.  
10. Once they master tight areas, work on going up inclines.

Biking From a Complete Stop  

1. Determine the child’s balance leg – it’s usually the first leg they put down when they stop.  
2. Once that’s determined, the balance leg is the leg that will stay on the ground and will be pushing to get the bike going.  The other leg goes on the pedal (pedal leg).  
3. Teach the child to position the pedal (pedal leg side) in front of their shin so they can easily put their foot on it.  
4. Ask them to have the balance leg push on the ground while the pedal leg is pushing down on the pedal to start the bike .

Cycling Benefits

I hope this blog has been helpful wherever your child is on their cycling journey! Teaching children to cycle has numerous benefits to their development, including improving motor skills, strength and balance. It’s also a fun exercise that can be enjoyed with a sibling or friend!

if you ever have concerns about your child’s mobility, strength, or motor skills, Easterseals DuPage & Fox Valley is here to help! Learn more about our physical therapy services by visiting:
https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/physical-therapy.

We also invite your family to join our annual Bike for the Kids in Elgin!

Cyclists of all ages and abilities are welcome to ride distances ranging from 12 miles – 50 miles or join us in reaching a 100-mile goal throughout the summer on the Strava app. Adapted bikes and trailers are welcome. All ages and abilities are encouraged to participate.

We are excited to take this ride to the Fox River Trail and celebrate together at Festival Park in Elgin with food, refreshment, entertainment and more!

Learn more and register here: https://www.givegab.com/campaigns/bikeforthekids2022

Positioning and Mobility Clinic Overview

By: Allie Katsiris, PT, DPT

What Does the Mobility Clinic Do?

The Positioning and Mobility Clinic at Easterseals provides a comprehensive evaluation of a child’s adaptive equipment needs. It is a collaborative clinic consisting of a physical therapist (PT) and an assistive technology professional (ATP) from a durable medical equipment vendor. Of course, the child and their family members are also valued members of the team. The two vendors that attend clinics at Easterseals are Numotion and National Seating and Mobility. There are a lot of options for seating and mobility devices available on the market, so the PT and ATP will utilize their knowledge, experience, and expertise to recommend the most appropriate equipment for your child.

The Process

At the initial evaluation, the PT and ATP will complete a comprehensive evaluation of the child including assessment of posture, range of motion, functional mobility skills, home assessment, and child/caregiver goals. Recommended mobility equipment may include: adaptive strollers, manual wheelchairs, power wheelchairs, or power assist wheelchairs. The clinician will also assess the need for specialized car seats or adaptive bathing equipment.

Following the initial evaluation, the PT will write a letter of medical necessity for the device. This letter will be sent to the child’s physician to be reviewed and signed. The vendor will submit the order and the letter to this insurance company for approval. Once approved, the device is ordered then delivered to the child. The PT and ATP work closely upon delivery to ensure the child is positioned appropriately and that the family understands all features for safe and effective use of the device. We recommended yearly rechecks to ensure that the device continues to properly support the child.

Home and Environmental Factors we Consider

There are many factors that are considered when deciding on a mobility device. In addition to evaluating postural alignment and medical history, the team will ask about your child’s current mobility skills and goals. We will consult with primary therapists as needed to best understand your child’s abilities, functional goals, and endurance level in order to best recommend a mobility device. The team will also ask about your child’s home and school environments. Some considerations include: whether your home has stairs, location of the child’s bedroom/bathroom, and width of doorways.

It is important that the child be able to utilize recommended equipment in all environments to promote his/her best alignment and independence. Another important factor in recommending a mobility device is how the child is transported. Do you drive a compact car or SUV? Do you have an adapted vehicle? Does your child ride the school bus? The answer to these questions will help guide to whether a folding or non-folding option and transit accessories are required. Due to insurance limitations and expectations that mobility equipment will last 5-10 years, it is important that all of these factors, growth, and future needs are considered in order for the equipment to support the child for years to come.

Quick facts about the various types of equipment:

Adaptive Strollers:

• Provide support for children who have decreased postural control, endurance, or safety in the community.
• They are typically lighter weight than wheelchairs and fold more easily.
• There are some limits to the customization of these devices.

Manual wheelchairs:

• Provide postural support for children who walk with limited endurance or who are unable to walk.
• A child can push/ move this device independently.
• There are folding and non-folding options.
• Can be customized to fit a child’s needs.

Tilt in Space wheelchairs:

• Provide postural support and can tilt backward for rest breaks or medical needs.
• Children are dependent on caregivers to propel the device.
• There are folding and non-folding options; although they tend to be bulkier than manual wheelchairs.
• Can be customized to fit a child’s needs.

Power wheelchairs:

• Provide postural support and power control
• Can be operated by the child.
• These are unable to fold so the family should consider home and car accessibility.
• Can be customized to fit a child’s needs.

How to Get Started

At Easterseals DuPage and Fox Valley, we appreciate the importance of providing children with a safe means of mobility. This allows children better access to their communities and increases overall participation with their family and peers. We also recognize that the equipment ordering process can be overwhelming, so we are here to support you and help your child obtain the equipment he/she needs to thrive! Please contact us to schedule an appointment: 630-282-2023 or click here to learn more.

Recommendations for Pacifiers

By: Jessica Drake-Simmons M.S. CCC-SLP

Babies show a natural tendency to suck on fingers and thumbs from the time they are in utero.  Sucking provides comfort and is a natural way for babies to explore the environment.  Allowing a baby to suck on a pacifier can have the advantages of helping to sooth a fussy baby, providing a distraction and helping a baby fall asleep.   Additionally, pacifiers may help minimize reflux.  The Mayo Clinic suggests that a pacifier could help reduce the risk of sudden infant death syndrome when used at nap time and bedtime.

The problem with pacifiers comes when little ones become dependent on them.  As a speech-language pathologist, seeing kids more frequently in their toddler years and beyond, I see some of the detrimental effects that persistent pacifier use can cause.  The preferred oral rest posture is having the lips closed, tongue placed up against the roof of the mouth, a slight space between the teeth and nasal breathing.  This oral rest posture supports dental alignment and wide rounded dental arches. Prolonged pacifier use (or other sucking habits) can cause a child’s teeth to be misaligned or not come in properly.

A study from Van Norman, 2001 found that 60% of dental malocclusions were related to sucking habits.  When the shape of the roof of the mouth is changed and dental malocclusions are created, kids can develop articulation errors such as a forward tongue position for production of /s/ (lisping).  Obstructing the mouth with a pacifier can negatively impact babbling and imitation of sounds.  Additionally, there is a correlation between pacifier use and increased incidence of ear infections.  Frequent ear infections are a common cause of speech and language delays.

Guidelines to follow for pacifier use:

• The American Academy of Pediatrics recommends waiting to offer a pacifier until a baby is 3-4 weeks old when breast feeding is well established.
• Don’t use the pacifier as a first line of defense. Try other strategies such as changing positions or rocking the baby to sooth them. 
• Use the appropriate size pacifier for your babies age in order to help maintain correct jaw alignment.
• Recommendations vary between 6 months and 2 years for when it is appropriate to discontinue pacifier use. It can be easiest to wean the pacifier by the time a baby is 12 months.
• Use pacifiers that are rounded on all sides. This allows for a more natural position of the tongue during non-nutritive sucking.

For help with discontinuing pacifier use: http://www.orofacialmyology.com/StopPacifier

To learn more about speech language-pathology and Easter Seals DuPage & Fox Valley visit eastersealsdfvr.org

Everyone Sitting at the Table: The Power of Family Meals

By: Emily Mitchell, Easter Seals DuPage & Fox Valley and Northern Illinois University Dietetic Intern & Candidate for Masters in Nutrition and Dietetics

When was the last time your entire family sat down for a meal together? You are an extremely influential role model for your child, and your actions and emotions are essential for your child’s growth and development. Your child learns through experiences and modeling behaviors, so try using meal time as a chance to work towards developmental milestones!

Family Style Meal Service

The environment in which meals are served can impact a toddler’s willingness to try new foods and develop healthy dietary patterns. Family style meals have been shown to be an effective approach in creating an environment conducive to establishing healthy behaviors in the home, as well as in schools and daycare facilities. Most importantly, family style meal service approaches mealtime as a learning experience.

The objectives of family style meal service include:

• Helping children develop positive attitudes towards nutritious foods
• Learning to engage in social eating situations
• Developing healthy eating patterns

Child involvement is integral to the concept of family style meal service, and can be done by allowing children to do the following things:

• Be the “produce picker” at the store
• Assist with meal preparation
• Set the table places
• Engage in conversation during the meal
• Assist with clean up

Involvement in meal time may look different for each child based on their developmental abilities. When establishing family meals, it is important that children are not only provided guidance through physical assistance and engaging in appropriate social exchanges, such as taking turns, but are also given age appropriate serving utensils and dishware to establish age appropriate portions.

Meal Time- It’s Not Just About Food and Nutrition!

Again, meal time is not solely about food and nutrition; it also provides parents the opportunity to model social, communication and motor skills. Approach mealtime as a learning experience and remember that meal time serves not only to help children develop positive attitudes towards nutritious foods, but also learn to engage in social eating situations, and develop motor skills.

In order to hone in on social, communication and motor skills, involving your child in meal time is key! Conversations during meal time provide an opportunity to enhance family connection and establish relationships among all members of the family. It is a chance to share information or news about your day.

Benefits and Barriers to Family Meals

Family meals have been shown to foster happy, well- adjusted kids. Research has shown that family meals have many benefits, including:

• Opportunities for modeling healthy behaviors
• Increase autonomy in children
• Enhance communication and social skills
• Heighten family connectedness
• Develop motor skills
• Encourage nutritious meals

Despite the many benefits of family meals, it can be trouble to do because of, child behavior problems, scheduling difficulties, and lack of self-efficacy in meal preparation.

What About My Child on Tube Feedings?

How do you involve everyone in the meal? Just as children consume food orally, your child on a tube feeding can use family meal time to socialize, interact, and learn. Have meal time conversations that are about more than the food. Look beyond the calorie nourishment of meal times and include your child receiving tube feedings in meal time, so they can receive the many qualities of meal times.

What is So Powerful About Meal Time?

The real power of meal time is the interpersonal quality. Kids like eating with their families, so allow for some fun! It is understandable that meal time may be frustrating at times, but try to make it as positive of an experience as possible. Dinner may be the one time during the day that a parent and child can share a positive experience—a yummy meal, a joke, or a story. Many children strive for autonomy, so as discussed previously, involve your kids in meal time and allow for learning and laughter! These special moments created at the table help gain momentum for your child’s development away from the table.

Your challenge–schedule time spent at the table with your family into your day!

If you find your child has nutrition problems including failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders or others schedule a nutritional evaluation with Easter Seals DuPage & Fox Valley today. Learn more at eastersealsdfvr.org/nutrition.

How to Prevent Your Baby From Getting a Flat Head

By: Bridget Hobbs, PT, DPT

You probably have seen them on babies in the mall, grocery store and at the park.  Baby helmets are everywhere!  Helmets have been used for a long time for safety with children that have seizures, but more recently they are also used to help mold babies’ heads that are flat back into a round shape.

Babies can have flat heads from crowding in-utero, which is very common with multiples.  However, there is an increasing number of cases of babies with flat head from positioning (or lack there-of) after they are born.   In fact, according to an article in the August 2013 issue of Pediatrics , 46.6 % of 440 infants studied from 7 to 12 weeks of age had positional plagiocephaly, or a flat head. Granted 78.3 % of children in the cohort study had a mild form of the condition; it does reveal that positional plagiocephaly is a very common occurrence these days.

When your baby is born, her skull is very soft which has allowed her to travel through the birth canal.  They flexibility of the skull also allows for brain growth in the first years of life.  Because of this softness, the skull is very moldable.  Spending long periods of time in one position can lead to flatness of the side of the head (plagiocephaly) or back of the head (brachycephaly).

The good news is that positional plagiocephaly is preventable.  Here are some tips that can help you manage your little ones’ head shape from day one.

• Alternate the arm in which you carry your child. If you are right handed, it’s really tempting to just hold your baby in your left arm so it frees up the right hand to grab your cup of coffee or something out of the fridge.  However, when you just hold your baby in one arm, they are likely just using their neck muscles to look outward to one side.  Alternating which arm you use for carrying your baby encourages them to look both ways often, making their neck muscles strong and less likely to be tight on one side. Tightness on one side of the neck, otherwise known as torticollis, makes it difficult for your child to change their head position, which can lead to flat head.    In fact, many babies that have torticollis (tightness on one side of the neck) also have plagiocephaly (flat head).

• When placing your baby down to sleep, alternate what side of the crib your baby’s head is on. This way, if baby is looking toward the door of the nursery or at a night light, they are alternating which side they are looking each night (or nap).  You can also switch which side of the changing pad you place your babies’ head when changing their diaper so they are looking both ways equally.  As a reminder, always place your child on their back to sleep.

• Limit the time that your baby is in a container, for example car seats, strollers, bouncy seats and swings. Your baby does not have the ability to move her neck very much when placed in these containers, which can lead to tight neck muscles and flatness of the head.  As a mom of an infant myself, I know it is tempting to leave your child in the car seat when they fall asleep after being in the car.  Once in a while it is fine, and I am certainly guilty of it myself.  However, repeated naps in car seats can quickly become a problem.

• Tummy time! I can’t say this enough…start tummy time early and do it often with your baby.  Some babies really don’t like it, but stick with it and they will gradually get used to it.  If they are really fussy, wait 1 hour after feeding to give their tummies time to settle after a meal.   For more tips on how to make tummy time easier for your child (and you!), refer to my previous blog “Yes! We Want Your Baby to Crawl!”

Tummy time is a good way to prevent positional plagiocephaly. Photo by Lorae Mundt

Because of the “back to sleep” program, which started in 1992, babies are not on their tummies as much.  The back to sleep program has done an excellent job at reducing SIDS, but the tradeoff is that many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy.   This often leads to physical therapy and a possible appointment at your nearest orthotist or baby helmet clinic.

Luckily, there are many clinics in the area that treat children with torticollis and plagiocephaly.  There are even specialized clinics that just fit babies for helmets and monitor their progress with head shape.  Most children have to wear baby head shaping helmets for a few months before they see good results with their head shape.

Pediatric physical therapy helps with stretching out tight muscles and strengthening weak neck muscles.   It also helps your child with their gross motor skills, such as rolling, crawling and standing, which can often be impacted by tight neck muscles and/or a flat head.   If your child has a flat head and/or tight neck muscles, schedule a physical therapy evaluation with a pediatric physical therapist at Easter Seals Dupage & Fox Valley by calling 630.261.6287.